Risk factors for epilepsy after thrombolysis for ischemic stroke : a cohort study

The effects of thrombolysis in seizure and epilepsy after acute ischemic stroke have been poorly explored. In this study, we examine risk factors and consequences of intravenous rt-PA for treatment of acute ischemic stroke. In a retrospective cohort study we evaluate risk factors for seizure and epilepsy after stroke thrombolysis, as well as the impact of seizures and epilepsy in outcome of stroke patients. In our cohort, mean age of patients was 67.2 years old (SD = 13.1) and 79 of them (51.6%) were male and. Initial NIHSS mean score were 10.95 (SD = 6.25). Three months NIHSS mean score was 2.09 (SD = 3.55). Eighty seven (56.9%) patients were mRS of 0–1 after thrombolysis. Hemorrhagic transformation was observed in 22 (14.4%) patients. Twenty-one (13.7%) patients had seizures and 15 (9.8%) patients developed epilepsy after thrombolysis. Seizures were independently associated with hemorrhagic transformation (OR = 3.26; 95% CI = 1.08–9.78; p = 0.035) and with mRS >= 2 at 3 months after stroke (OR = 3.51; 95% CI = 1.20–10.32; p = 0.022). Hemorrhagic transformation (OR = 3.55; 95% CI = 1.11–11.34; p = 0.033) and mRS >= 2 at 3 months (OR = 5.82; 95% CI = 1.45–23.42; p = 0.013) were variables independently associated with post-stroke epilepsy. In our study, independent risks factors for poor outcome in stroke thrombolysis were age (OR = 1.03; 95% CI = 1.01–1.06; p = 0.011), higher NIHSS (OR = 1.08; 95% CI = 1.03– 1.14; p = 0.001), hemorrhagic transformation (OR = 2.33; 95% CI = 1.11–4.76; p = 0.024), seizures (OR = 3.07; 95% CI = 1.22–7.75; p = 0.018) and large cortical area (ASPECTS <= 7) (OR = 2.04; 95% CI = 1.04–3.84; p = 0.036). Concluding, in this retrospective cohort study, the neurological impairment after thrombolysis (but not before) and hemorrhagic transformation remained independent risk factors for seizures or post-stroke epilepsy after thrombolysis. Moreover, we observed that seizures emerged as an independent risk factor for poor outcome after thrombolysis therapy in stroke patients (OR = 3.07; 95% CI = 1.22–7.75; p = 0.018)

Vulnerabilidade para o comportamento sexual de risco em usuários de álcool e outras drogas

OBJECTIVES: to evaluate the association between alcohol use and other drugs, socio-demographic variables and psychosocial aspects, with the users risky sexual behavior.METHODS: cross-sectional quantitative research, interviewed 110 users of a Center for Psychosocial Care in Alcohol and Other Drugs (CAPSad) with the Global Assessment of Individual Needs instrument. The Sexual Risk Scale, sociodemographic characteristics, days of drug use and other subscales of instrument were used.RESULTS: risky sexual behavior was significant in users who were more days on crack use, in homeless and more severe in psychosocial aspects.CONCLUSION: daily users factors have important influences on sexual risk behavior and sexually transmitted diseases.Objectives: to evaluate the association between alcohol use and other drugs, socio-demographic variables and psychosocial aspects, with the users risky sexual behavior. Methods: cross-sectional quantitative research, interviewed 110 users of a Center for Psychosocial Care in Alcohol and Other Drugs (CAPSad) with the Global Assessment of Individual Needs instrument. The Sexual Risk Scale, sociodemographic characteristics, days of drug use and other subscales of instrument were used. Results: risky sexual behavior was significant in users who were more days on crack use, in homeless and more severe in psychosocial aspects. Conclusion: daily users factors have important influences on sexual risk behavior and sexually transmitted diseases.Objetivos: avaliar a associação entre o uso de álcool e outras drogas, variáveis sóciodemográficas e aspectos psicossociais, com o comportamento sexual de risco dos usuários. Métodos: pesquisa quantitativa transversal, entrevistados 110 usuários de um Centro de Atenção Psicossocial em Álcool e outras Drogas (CAPSad) com o instrumento Avaliação Global das Necessidades Individuais. Utilizou-se a Escala de Risco Sexual, características sociodemográficas, dias de uso de drogas e demais subescalas do instrumento. Resultados: o comportamento sexual de risco foi significativo em usuários que estavam a mais dias em uso de crack, em situação de rua e mais graves em aspectos psicossociais. Conclusão: fatores do cotidiano dos usuários tem influências importantes sobre o comportamento sexual de risco e doenças sexualmente transmissíveis

Early mobilization in ischemic stroke : a pilot randomized trial of safety and feasibility in a public hospital in Brazil

Abstract Background: The effect of early mobilization after acute stroke is still unclear, although some studies have suggested improvement in outcomes. We conducted a randomized, single-blind, controlled trial seeking to evaluate the feasibility, safety, and benefit of early mobilization for patients with acute ischemic stroke treated in a public teaching hospital in Southern Brazil. This report presents the feasibility and safety findings for the pilot phase of this trial. Methods: The primary outcomes were time to first mobilization, total duration of mobilization, complications during early mobilization, falls within 3 months, mortality within 3 months, and medical complications of immobility. We included adult patients with CT- or MRI-confirmed ischemic stroke within 48 h of symptom onset who were admitted from March to November 2012 to the acute vascular unit or general emergency unit of a large urban emergency department (ED) at the Hospital de Clínicas de Porto Alegre. The severity of the neurological deficit on admission was assessed by the National Institutes of Health Stroke Scale (NIHSS). The NIHSS and modified Rankin Scale (mRS, functional outcome) scores were assessed on day 14 or at discharge as well as at 3 months. Activities of daily living (ADL) were measured with the modified Barthel Index (mBI) at 3 months. Results: Thirty-seven patients (mean age 65 years, mean NIHSS score 11) were randomly allocated to an intervention group (IG) or a control group (CG). The IG received earlier (p = 0.001) and more frequent (p < 0.0001) mobilization than the CG. Of the 19 patients in the CG, only 5 (26%) underwent a physical therapy program during hospitalization. No complications (symptomatic hypotension or worsening of neurological symptoms) were observed in association with early mobilization. The rates of complications of immobility (pneumonia, pulmonary embolism, and deep vein thrombosis) and mortality were similar in the two groups. No statistically significant differences in functional independence, disability, or ADL (mBI ≥ 85) were observed between the groups at the 3-month follow-up. Conclusions: This pilot trial conducted at a public hospital in Brazil suggests that early mobilization after acute ischemic stroke is safe and feasible. Despite some challenges and limitations, early mobilization was successfully implemented, even in the setting of a large, complex ED, and without complications. Patients from the IG were mobilized much earlier than controls receiving the standard care provided in most Brazilian hospitals

Memory Networks in Tinnitus: A Functional Brain Image Study

Tinnitus is characterized by the perception of sound in the absence of an external auditory stimulus. the network connectivity of auditory and non-auditory brain structures associated with emotion, memory and attention are functionally altered in debilitating tinnitus. Current studies suggest that tinnitus results from neuroplastic changes in the frontal and limbic temporal regions. the objective of this study was to use Single-Photon Emission Computed Tomography (SPECT) to evaluate changes in the cerebral blood flow in tinnitus patients with normal hearing compared with healthy controls. Methods: Twenty tinnitus patients with normal hearing and 17 healthy controls, matched for sex, age and years of education, were subjected to Single Photon Emission Computed Tomography using the radiotracer ethylenedicysteine diethyl ester, labeled with Technetium 99 m (99 mTc-ECD SPECT). the severity of tinnitus was assessed using the Tinnitus Handicap Inventory (THI). the images were processed and analyzed using Statistical Parametric Mapping (SPM8). Results: A significant increase in cerebral perfusion in the left parahippocampal gyrus (pFWE<0.05) was observed in patients with tinnitus compared with healthy controls. the average total THI score was 50.8+18.24, classified as moderate tinnitus. Conclusion: It was possible to identify significant changes in the limbic system of the brain perfusion in tinnitus patients with normal hearing, suggesting that central mechanisms, not specific to the auditory pathway, are involved in the pathophysiology of symptoms, even in the absence of clinically diagnosed peripheral changes.Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)Universidade Federal de São Paulo, Dept Psiquiatria, LiNC, São Paulo, BrazilUniversidade Federal de São Paulo, Dept Otorrinolaringol & Cirurgia Cabeca & Pescoco, São Paulo, BrazilUniversidade Federal de São Paulo, Dept Radiol, Secao Med Nucl, São Paulo, BrazilHosp Israelita Albert Einstein, Inst Cerebro, São Paulo, BrazilUniversidade Federal de São Paulo, Dept Fonoaudiol, São Paulo, BrazilUniv Western Australia, Med Res Ctr, Western Australian Ctr Hlth & Ageing, Perth, WA 6009, AustraliaUniversidade Federal de São Paulo, Dept Psiquiatria, LiNC, São Paulo, BrazilUniversidade Federal de São Paulo, Dept Otorrinolaringol & Cirurgia Cabeca & Pescoco, São Paulo, BrazilUniversidade Federal de São Paulo, Dept Radiol, Secao Med Nucl, São Paulo, BrazilUniversidade Federal de São Paulo, Dept Fonoaudiol, São Paulo, BrazilFAPESP: FAPESP-2010/14804-6Web of Scienc

Protective Effects of Tropical Fruit Processing Coproducts on Probiotic Lactobacillus Strains during Freeze-Drying and Storage

This study evaluated the protective effects of coproducts from agroindustrial processing of the tropical fruits acerola (Malpighia glabra L., ACE), cashew (Anacardium occidentale L., CAS), and guava (Psidium guayaba L., GUA) on the probiotics Lactobacillus paracasei L-10, Lactobacillus casei L-26, and Lactobacillus acidophilus LA-05 during freeze-drying and storage. The occurrence of damage to membrane integrity, membrane potential, and efflux activity of Lactobacillus cells after freeze-drying was evaluated by flow cytometry, and viable counts were measured immediately after freeze-drying and during 90 days of storage under refrigerated or room temperature conditions. Probiotic strains freeze-dried without substrate had the overall highest count reductions (0.5 ± 0.1 to 2.9 ± 0.3 log cycles) after freeze-drying. Probiotics freeze-dried with fruit processing coproducts had small cell subpopulations with damaged efflux activity and membrane potential. Average counts of probiotics freeze-dried with ACE, CAS, or GUA after 90 days of storage under refrigerated or room temperature were in the range of 4.2 ± 0.1 to 5.3 ± 0.2 and 2.6 ± 0.3 to 4.9 ± 0.2 log CFU/g, respectively, which were higher than those observed for strains freeze-dried without substrate. The greatest protective effects on freeze-dried probiotics were overall presented by ACE. These results revealed that ACE, CAS, and GUA can exert protective effects and increase the stability of probiotic lactobacilli during freeze-drying and storage, in addition to supporting a possible added-value destination for these agroindustrial coproducts as vehicles for probiotics and for the development of novel functional foods.Fil: Araújo, Caroliny Mesquita. Universidade Federal Da Paraiba; BrasilFil: Sampaio, Karoliny Brito. Universidade Federal Da Paraiba; BrasilFil: Dantas Duarte Menezes, Francisca Nayara. Universidade Federal Da Paraiba; BrasilFil: Tayse da Cruz Almeida, Erika. Universidade Federal Da Paraiba; BrasilFil: Lima, Marcos dos Santos. Instituto Federal do Sertão de Pernambuco. Departamento de Tecnologia de Alimentos; BrasilFil: Bordin Viera, Vanessa. Universidade Federal Campina Grande. Centro de Educação e Saúde; BrasilFil: Fernandez Garcia, Estefânia. Universidade Federal Da Paraiba; BrasilFil: Gomez Zavaglia, Andrea. Provincia de Buenos Aires. Gobernación. Comisión de Investigaciones Científicas. Centro de Investigación y Desarrollo en Criotecnología de Alimentos. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - La Plata. Centro de Investigación y Desarrollo en Criotecnología de Alimentos. Universidad Nacional de La Plata. Facultad de Ciencias Exactas. Centro de Investigación y Desarrollo en Criotecnología de Alimentos; ArgentinaFil: Leite de Souza, Evandro. Universidade Federal Da Paraiba; BrasilFil: Gomes de Oliveira, Maria Elieidy. Universidade Federal Da Paraiba; Brasi

Cerebral Autosomal-Dominant Arteriopathy with Subcortical Infarcts and Leukoencephalopathy – CADASIL

We report here neuroimaging findings of a  41 years-old female with molecular diagnosis of CADASIL (Cerebral Autosomal-Dominant Arteriopathy with Subcortical Infarcts and Leukoencephalopathy). CADASIL, the most common form of hereditary stroke, is characterized by headaches and relapsing strokes. More than 95% of patients present mutations of NOTCH3 gene. MRI, the best neuroimaging modality to investigate CADASIL can show lacunar infarcts and less-well demarcated T2 weighted hyperintensities characteristically located in subcortical white matter. There is no specific treatment for CADASIL. Anti-platelet agents such as aspirin might help to prevent new strokes. Other symptoms, like headache, seizures, or other neuropsychiatric manifestations should be appropriately treated